乳腺癌急性放射性皮炎防治及护理研究进展

doi:10.3760/cma.j.issn.1007-1245.2022.19.008

摘要/Abstract

摘要： 急性放射性皮炎是乳腺癌患者放射治疗过程中最常见的并发症之一，严重时影响患者治疗依从性，导致放疗中断。积极防治及有效护理可延缓皮肤损伤出现时间，减轻损伤程度，加快损伤修复。但目前国内外尚未有统一的防治标准。本文总结概述了乳腺癌急性放射性皮炎的发病机制、分级评估标准、一般支持性护理及针对性防治措施，以期为临床护理实践提供指导。

关键词: 乳腺癌, 急性放射性皮炎, 护理

Abstract: Acute radiation dermatitis is one of the most common complications during the course of radiation therapy for patients with breast cancer, and seriously affects patient treatment compliance and leads to interruption of radiotherapy. Good nursing management can effectively delay the time of appearance of skin lesions, reduce the extent of damage, and accelerate damage repair. However, at present, there is no uniform control standard at home and abroad. This article provides a summary of the pathogenesis, grading assessment criteria, general supportive care, and targeted prevention and treatment measures for acute radiation dermatitis of patients with breast cancer, so as to provide guidance for clinical nursing practice.

Key words: t cancer, Acute radiation dermatitis, Nursing

李进杨惠敏邢桃红姚颖张冰妍. 乳腺癌急性放射性皮炎防治及护理研究进展[J]. 国际医药卫生导报, 2022, 28(19): 2699-2704.

Li Jin, Yang Huimin, Xing Taohong, Yao Ying, Zhang Bingyan. Research progress in prevention, treatment, and nursing of acute radiation dermatitis in patients with breast cancer[J]. International Medicine and Health Guidance News, 2022, 28(19): 2699-2704.

参考文献

[1] Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249. DOI: 10.3322/caac.21660.
[2] Nasser NJ, Fenig S, Ravid A, et al. Vitamin D ointment for prevention of radiation dermatitis in breast cancer patients[J]. NPJ Breast Cancer, 2017, 3: 10. DOI: 10.1038/s41523-017-0006-x.
[3] Bolton L. Acute radiation therapy-related dermatitis[J]. Wounds, 2020, 32(2): 66-68.
[4] Yang X, Ren H, Guo X, et al. Radiation-induced skin injury: pathogenesis, treatment, and management [J]. Aging (Albany NY), 2020, 12(22): 23379-23393. DOI: 10.18632/aging.103932
[5] Leventhal J, Young M R. Radiation dermatitis: recognition, prevention, and management [J]. Oncology (Williston Park), 2017, 31(12): 885-887, 894-899
[6] Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European organization for research and treatment of cancer (EORTC) [J]. Int J Radiat Oncol Biol Phys, 1995, 31(5): 1341-1346. DOI: 10.1016/0360-3016(95)00060-C.
[7] Atkinson TM, Ryan SJ, Bennett AV, et al. The association between clinician-based common terminology criteria for adverse events (CTCAE) and patient-reported outcomes (PRO): a systematic review [J]. Support Care Cancer, 2016, 24(8): 3669-3676. DOI: 10.1007/s00520-016- 3297-9.
[8] Wong RKS, Bensadoun R, Boers-Doets CB, et al. Clinical practice guidelines for the prevention and treatment of acute and late radiation reactions from the MASCC Skin Toxicity Study Group[J]. Support Care Cancer, 2013, 21(10): 2933-2948. DOI: 10.1007/s00520-013-1896-2.
[9] 中华医学会医学美容与美学分会皮肤美容学组. 放射性皮炎诊疗专家共识[J]. 中华医学美学美容杂志, 2021, 27(5):353-357. DOI:10.3760/cma.j.issn.1671-0290. 2021.05.001.
[10] 高杰, 孙吉明. 胸部肿瘤患者接受放射治疗时双手的摆放位置对摆位误差的影响分析[J]. 国际医药卫生导报, 2020(7):902-903. DOI: 10.3760/cma.j.issn.1007-1245. 2020.07.004.
[11] 李涛, 吕家华, 郎锦义, 等. 恶性肿瘤放疗患者营养治疗专家共识[J/CD]. 肿瘤代谢与营养电子杂志, 2018,5(4):358-365. DOI:10.16689/j.cnki.cn11-9349/r.2018.04.006.
[12] Limon-Miro AT, Lopez-Teros V, Astiazaran-Garcia H. Dietary guidelines for breast cancer patients: a critical review [J]. Adv Nutr, 2017, 8(4): 613-623. DOI: 10.3945/an.116.014423.
[13] Fukushi Y, Mariya Y, Yamada K, et al. Tomato juice consumption could improve breast skin adverse effects of radiotherapy in breast cancer patients [J]. In Vivo, 2020, 34(5): 3013-3021. DOI: 10.21873/invivo.12133
[14] Eda K, Uzer K, Murat T, et al. The effects of enteral glutamine on radiotherapy induced dermatitis in breast cancer[J]. Clin Nutr, 2016, 35(2): 436-439. DOI: 10.1016/j.clnu.2015.03.009
[15] Klement RJ, Weigel MM, Sweeney RA. A ketogenic diet consumed during radiotherapy improves several aspects of quality of life and metabolic health in women with breast cancer[J]. Clin Nutr, 2021, 40(6): 4267-4274. DOI: 10.1016/j.clnu.2021.01.023.
[16] Icard P, Ollivier L, Forgez P, et al. perspective: do fasting, caloric restriction, and diets increase sensitivity to radiotherapy? A literature review [J]. Adv Nutr, 2020, 11(5):1089-1101. DOI: 10.1093/advances/nmaa062.
[17] 谈艳, 卞晶晶, 汤露. Delphi咨询法构建乳腺癌放疗系统护理干预体系[J]. 齐鲁护理杂志, 2021, 27(7):97-99. DOI: 10.3969 /j.issn.1006-7256.2021.07.036.
[18] 吴杰, 金云玉, 董丽华. 全面引导护理对乳腺癌放疗患者护理质量的影响[J]. 中华全科医学, 2019,17(4): 678-681. DOI: 10.16766 /j.cnki.issn.1674-152.000765.
[19] 黄梨花. 标准化皮肤护理干预对乳腺癌放射治疗后皮肤损害修复的影响[J]. 护理实践与研究, 2017, 14(14):105-107. DOI: 10. 3969/j. issn.1672-9676. 2017.14.045.
[20] Wang X, Lai Q, Tian Y, et al. Effect of evidence-based nursing intervention on upper limb function in postoperative radiotherapy patients with breast cancer [J]. Medicine (Baltimore), 2020, 99(11):e19183. DOI: 10.1097/MD.0000000000019183.
[21] 吴慧英. 乳腺癌术后放疗患者患侧上肢穴位按揉的效果观察[J]. 护理学报, 2011,18(19):65-66. DOI:10.16460/j.issn1008-9969.2011.19.022.
[22] Shaverdian N, Wang X, Hegde J V, et al. The patient's perspective on breast radiotherapy: Initial fears and expectations versus reality[J]. Cancer-Am Cancer Soc, 2018,124(8):1673-1681.DOI: 10.1002/cncr.31159.
[23] Kim K, Park H. Factors affecting anxiety and depression in young breast cancer survivors undergoing radiotherapy [J]. Eur J Oncol Nurs, 2021,50:101898.DOI: 10.1016/j.ejon.2021.101898.
[24] Sharma N, Purkayastha A. Impact of radiotherapy on psychological, financial, and sexual aspects in postmastectomy carcinoma breast patients: a prospective study and management[J]. Asia Pac J Oncol Nurs, 2017, 4(1): 69-76. DOI: 10.4103/2347-5625.199075
[25] Jimenez YA, Cumming S, Wang W, et al. Patient education using virtual reality increases knowledge and positive experience for breast cancer patients undergoing radiation therapy [J]. Support Care Cancer, 2018, 26(8): 2879-2888. DOI: 10.1007/s00520-018-4114-4.
[26] Halkett G, O'Connor M, Jefford M, et al. RT prepare: a radiation therapist-delivered intervention reduces psychological distress in women with breast cancer referred for radiotherapy[J]. Br J Cancer, 2018,118(12):1549-1558. DOI: 10.1038/s41416-018-0112-z.
[27] Chakrabarty J, Vidyasagar M S, Fernandes D, et al. Emotional aspects and pranayama in breast cancer patients undergoing radiation therapy: a randomized controlled trial[J]. Asia Pac J Oncol Nurs, 2016,3(2):199-204. DOI: 10.4103/2347-5625.177390.
[28] 栗文菊. 中医情志护理对乳腺癌放疗患者负性情绪及应激反应的影响[J]. 新中医, 2021,53(8):139-141. DOI.10.13457/j.cnki.jncm.2021.08.037.
[29] Rossetti A, Chadha M, Torres B N, et al. The impact of music therapy on anxiety in cancer patients undergoing simulation for radiation therapy [J]. Int J Radiat Oncol Biol Phys, 2017, 99(1): 103-110. DOI: 10.1016/j.ijrobp.2017.05.003.
[30] 沈傲梅,强万敏,王盈,等. 青年乳腺癌过渡期患者正念癌症康复干预研究[J]. 护理学杂志,2020,35(19):95-98. DOI:10.3870/j.issn.1001-4152.2020.19.095.
[31] 夏璐, 李国苗, 李志琳, 等. 三乙醇胺治疗乳腺癌术后放射性皮炎[J]. 现代肿瘤医学, 2019,27(09):1594-1597.DOI: 10.3969 /j.issn.1672-4992.2019.09.030.
[32] 李燕宁. 多磺酸粘多糖乳膏联合丁酸氢化可的松软膏治疗乳腺癌术后放射性皮炎的临床观察[J]. 临床皮肤科杂志, 2014,43(4):251-252.
[33] Shariati L, Amouheidari A, Naji EH, et al. Protective effects of doxepin cream on radiation dermatitis in breast cancer: a single arm double-blind randomized clinical trial [J]. Br J Clin Pharmacol, 2020,86(9):1875-1881.DOI: 10.1111/bcp.14238.
[34] Kawamori J, Itazawa T, Fukushima S, et al. Effect of heparinoid moisturizer on quality of life in patients with acute radiation skin damage following hypofractionated radiation therapy after breast-conserving surgery: a randomized controlled study[J]. Breast Cancer (Dove Med Press), 2021, 13: 743-753. DOI: 10.2147/BCTT.S347136.
[35] Sahin F, Pirouzpanah MB, Bijanpour H, et al. The preventive effects of boron-based gel on radiation dermatitis in patients being treated for breast cancer: a phase Ⅲ randomized, double-blind, placebo-controlled clinical trial[J]. Oncol Res Treat, 2022: 1-8. DOI: 10.1159/000520363.
[36] 蓝晓雯, 林潇, 何海艳, 等. 医用射线防护剂对比三乙醇胺乳膏防治乳腺癌改良根治术后放疗皮肤损伤临床观察[J]. 中华放射肿瘤学杂志, 2018, 27(9): 818-821. DOI: 10.3760/cma.j.issn.1004-4221.2018.09.006.
[37] 刘凌, 江锦芳. 奥克喷射线防护剂防治急性放射性皮炎效果的Meta分析[J]. 循证护理, 2020,6(8):745-750. DOI:10.12102/j.issn.2095-8668.2020.08.002.
[38] Kong M, Hong SE. Topical use of recombinant human epidermal growth factor (EGF)-based cream to prevent radiation dermatitis in breast cancer patients: a single-blind randomized preliminary study [J]. Asian Pac J Cancer Prev, 2013,14(8):4859-4864. DOI: 10.7314/apjcp. 2013.14.8.4859.
[39] 柳华锋. 中药溃疡油治疗放射性皮炎的临床观察[D]. 北京: 北京中医药大学, 2018.
[40] Geara FB, Eid T, Zouain N, et al. Randomized, prospective, open-label phase iii trial comparing mebo ointment with biafine cream for the management of acute dermatitis during radiotherapy for breast cancer [J]. Am J Clin Oncol, 2018, 41(12): 1257-1262. DOI: 10.1097/COC. 0000000000000460.
[41] 高丽,武霞. 湿润烧伤膏防治乳腺癌改良根治术后放射性皮肤损伤疗效观察[J]. 中国烧伤创疡杂志,2019,31(3):170-173. DOI:10.3969/j.issn.1001-0726.2019.03.005.
[42] 盖龙娴, 武霞. 湿润烧伤膏联合龙血竭防治乳腺癌改良根治术后放射性皮肤损伤疗效观察[J]. 中国烧伤创疡杂志, 2020,32(3):202-206.DOI:10.3969/j.issn.1001-0726. 2019.03.005.
[43] 杨学岩, 关丽丽. 京万红软膏治疗乳腺癌放射性皮肤损伤的疗效观察[J]. 实用药物与临床, 2014, 17(3):373-375.DOI:10.14053/j.cnki.ppcr.2014.03.017.
[44] 张家凯. 凉血解毒膏预防放射性皮炎的临床研究[D]. 石家庄: 河北医科大学, 2015.
[45] 陈勇. 紫草油联合三乙醇胺治疗放射性皮炎的临床观察[J]. 中国医药指南, 2015,13(13):20-21
[46] 康宁, 宋凤丽, 李京华, 等. 加味四妙勇安油治疗乳腺癌急性放射性皮炎的临床研究[J]. 现代中医临床, 2019,26(2):35-39. DOI:10.3969 /j.issn.2095-6606.2019.02.007
[47] Fernández-Castro M, Martín-Gil B, Peña-García I, et al. Effectiveness of semi-permeable dressings to treat radiation-induced skin reactions. A systematic review [J]. Eur J Cancer Care (Engl), 2017, 26(6). DOI: 10.1111/ecc.12685.
[48] 王霁, 华羽晨, 裴忠玲, 等. 自黏性软聚硅酮薄膜敷料和医用防护涂剂预防乳腺癌放射治疗患者皮肤损伤的效果分析[J]. 解放军护理杂志, 2018,35(19):69-71. DOI:10.3969/j .issn.1008-9993.2018.19 .015.
[49] Kenne SE, Mårtensson LB, Andersson BA, et al. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer[J]. Cancer Med, 2017, 6(5):1108-1122. DOI: 10.1002/cam4. 1052.
[50] 宋俊梅,胡欣. 赛肤润联合贝复剂对乳腺癌放射性皮肤损伤防治的疗效观察[J]. 川北医学院学报,2019,34(2):226-228. DOI:10.3969/j.issn.1005-3697.2019.02.17.
[51] Hemati S, Asnaashari O, Sarvizadeh M, et al. Topical silver sulfadiazine for the prevention of acute dermatitis during irradiation for breast cancer[J]. Support Care Cancer, 2012,20(8):1613-1618. DOI: 10.1007/s00520-011- 1250-5.
[52] 谯凌. 赛肤润联合活性银离子喷雾剂治疗乳腺癌放疗病人皮肤破溃的效果观察[J]. 全科护理,2020,18(34):4756-4758. DOI:10.12104/j.issn.1674-4748.2020.34.015.
[53] 马倩倩,陈延松,李淑华. 胶原抗菌功能性敷料预防乳腺癌放射性皮肤损伤的疗效观察[J]. 沈阳医学院学报,2021,23(2):149-152. DOI:10.16753/j.cnki.1008-2344. 2021. 02.013.
[54] Aguiar BRL, Guerra ENS, Normando AGC, et al. Effectiveness of photobiomodulation therapy in radiation dermatitis: a systematic review and meta-analysis [J]. Crit Rev Oncol Hematol, 2021, 162:103349. DOI: 10.1016/j.critrevonc.2021.103349.